radical_P
New member
Info on HRT written by SWALE
It is important to know (and very few physicians understand this) that it is in only the most severe cases of hypogonadism that serum testosterone levels actually drop below "normal."
And now we must discuss this word "normal". The range specified as such is made simply by putting bookends around the assays of 95% of all men tested. Well, it has been estimated that half of all men at the age of fifty are hypogonadal. And it is well established that hypogonadism leads, or contributes to, varied and severe comorbidities. Therefore, a significant portion of the men deemed "normal" by lab assay are in fact sick from hypogonadism. In other words, "normal" range has absolutely nothing to do with health and happiness; it is established purely by statistical methodology.
Now you see why I so despise the word "normal" as it applies to serum testosterone levels. Added to this is the fact this range is most often used by physicians to deny TRT to men who demonstate many, or all, of the clinical symptoms of hypogonadism. In that case, what is known as "therapeutic testing" should be employed. If a patient presents with the symptoms of hypogonadism, but is within the "normal" (there's that word again!) range, he should be treated with a modest amount of testosterone, until he reaches, perhaps, the upper quartile of serum testosterone range. If his clinical symptoms disappear, then that proves he had the disease in the first place!
What are the symptoms of hypogonadism? Lethargy, fatigue, depression (IMPO no man can be cured of depression while he is hypogonadal), weakness, loss of interest in life, loss of libido, erectile dysfunction. More seriously, there is a strong correlation between hypogonadism and heart disease, diabetes, osteoporosis and cancer. But what usually brings a patient into the office? Of course, erectile dysfunction!
In my practice, I use the top of Total Testosterone range as a practical limit. I will not willingly exceed such, because doing so is the same as prescribing steroids, which is illegal. I try to reach this range because it has been shown that as men approach the top of "normal' range, they tend to get healthier and happier. But when you exceed same, then things begin to move in the opposite direction--and the patient's health consequently begins to suffer. That would constitute a violation of my Oath as a physician.
At what age can we expect serum testosterone levels to drop to a point where health is compromised? In fact, I have pateints who are in their early twenties. However, generally, by the time a guy reaches his mid thirties, things are beginning to drop off. And as I previously stated, probably half the men at the age of fifty need TRT, IMPO.
It is important to know (and very few physicians understand this) that it is in only the most severe cases of hypogonadism that serum testosterone levels actually drop below "normal."
And now we must discuss this word "normal". The range specified as such is made simply by putting bookends around the assays of 95% of all men tested. Well, it has been estimated that half of all men at the age of fifty are hypogonadal. And it is well established that hypogonadism leads, or contributes to, varied and severe comorbidities. Therefore, a significant portion of the men deemed "normal" by lab assay are in fact sick from hypogonadism. In other words, "normal" range has absolutely nothing to do with health and happiness; it is established purely by statistical methodology.
Now you see why I so despise the word "normal" as it applies to serum testosterone levels. Added to this is the fact this range is most often used by physicians to deny TRT to men who demonstate many, or all, of the clinical symptoms of hypogonadism. In that case, what is known as "therapeutic testing" should be employed. If a patient presents with the symptoms of hypogonadism, but is within the "normal" (there's that word again!) range, he should be treated with a modest amount of testosterone, until he reaches, perhaps, the upper quartile of serum testosterone range. If his clinical symptoms disappear, then that proves he had the disease in the first place!
What are the symptoms of hypogonadism? Lethargy, fatigue, depression (IMPO no man can be cured of depression while he is hypogonadal), weakness, loss of interest in life, loss of libido, erectile dysfunction. More seriously, there is a strong correlation between hypogonadism and heart disease, diabetes, osteoporosis and cancer. But what usually brings a patient into the office? Of course, erectile dysfunction!
In my practice, I use the top of Total Testosterone range as a practical limit. I will not willingly exceed such, because doing so is the same as prescribing steroids, which is illegal. I try to reach this range because it has been shown that as men approach the top of "normal' range, they tend to get healthier and happier. But when you exceed same, then things begin to move in the opposite direction--and the patient's health consequently begins to suffer. That would constitute a violation of my Oath as a physician.
At what age can we expect serum testosterone levels to drop to a point where health is compromised? In fact, I have pateints who are in their early twenties. However, generally, by the time a guy reaches his mid thirties, things are beginning to drop off. And as I previously stated, probably half the men at the age of fifty need TRT, IMPO.
